- IRCCS Istituto Auxologico Italiano, Psychology Research Lab, Department Memberadd
- Motivational Interviewing, Cardiovascular disease, Obesity, Psychology, Clinical Health Psychology, Clinical Psychology, and 8 moreOverweight and Obesity, Eating Disorders, Heart Disease, Motivation (Psychology), Psychotherapy and Counseling, Solution Focused Brief Therapy; Strategic Therapy, Brief Strategic family therapy, and Research Methodologyedit
- Dr. Giada Pietrabissa, Ph.D., Psy.D. is a Research Fellow at the Catholic University of Milan. She also works as a Re... moreDr. Giada Pietrabissa, Ph.D., Psy.D. is a Research Fellow at the Catholic University of Milan. She also works as a Research Psychologist at the Institute for Treatment and Research (IRCCS) - Istituto Auxologico Italiano - Milan, where she provides individual and motivational-based group interventions to individuals with eating disorders, obesity, and other chronic conditions. She is the author of a number of articles published in academic and professional peer-review journals and book chapters, and she serves on the editorial board of numerous academic journals.
She has expert knowledge and experience in using a variety of therapeutic approaches including brief strategic and systemic therapy, motivational interviewing, and schema-focused therapy. She is a member of the International Academy of Body Image, Eating Problems and Health, of the Italian Association of Psychology (AIP), and of the Italian Scientific Society for the Study of Eating Disorders and Obesity (SIS-DCA).edit
Depression has been widely studied by researchers from different fields, but its causes, and mechanism of action are still not clear. A difficulty emerges from the shifting from objective diagnosis or analysis to explore the subjective... more
Depression has been widely studied by researchers from different fields, but its causes, and mechanism of action are still not clear. A difficulty emerges from the shifting from objective diagnosis or analysis to explore the subjective feelings and experiences that influence the individuals' expression, communication, and coping in facing depression. The integration of the experiential dimension of the first-person in studies on depression and related methodological recommendations are needed to improve the validity and generalizability of research findings. It will allow the development of timely and effective actions of care. Starting from providing a summary of the literature on theoretical assumptions and considerations for the study of the mind, with particular attention to the experiential dimension of patients with depression (aim #1 and #2), this contribution is aimed to provide practical suggestions for the design of research able to incorporate first-and third-person accounts (aim #3). It is also aimed to review qualified phenomenological methods for the acquisition and interpretation of experiential data in patients with depression (aim #4). Recognizing the first-person perspective in the study of depression is a major step toward a better understanding and treatment of this disorder. Theoretical constructs and technique suggestions that result from this review offer a valid starting point for the inclusion of the experiential dimension to common third-person research in the study of the mind.
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Objective: Symptom improvement is often examined as an indicator of a good outcome of accessing mental health services. However, there is little evidence of whether symptom improvement is associated with other indicators of a good... more
Objective: Symptom improvement is often examined as an indicator of a good outcome of accessing mental health services. However, there is little evidence of whether symptom improvement is associated with other indicators of a good outcome, such as a mutual agreement to end treatment. The aim of this study was to examine whether young people accessing mental health services who meaningfully improved were more likely to mutually agree to end treatment. Methods: Multilevel multinomial regression analysis controlling for age, gender, ethnicity, and referral source was conducted on N = 8,995 episodes of care [Female = 5,469, 61%; meanAge = 13.66 (SD = 2.87) years] using anonymised administrative data from young people's mental health services. Results: Compared to young people with no change in mental health difficulties, those showing positive meaningful changes in mental health difficulties were less likely to have case closure due to non-mutual agreement (Odds Ratio or OR = 0.58, 95% Confidence Interval or CI = 0.50-0.61). Similarly, they were less likely to transfer (OR = 0.61, 95% CI = 0.49-0.74) or end treatment for other reasons (OR = 0.59, 95% CI = 0.50-0.70) than by case closure due to mutual agreement. Conclusion: The findings suggest that young people accessing mental health services whose symptoms meaningfully improve are more likely to mutually agree to end treatment, adding to the evidence that symptom improvement may be appropriate to examine as an indicator of a good outcome of accessing mental health services.
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Population aging with longer life expectancy represents one of the most relevant challenges of the next future, also because of a significant proportion of older adult people may present with dementia. Motivating senior citizens with mild... more
Population aging with longer life expectancy represents one of the most relevant challenges of the next future, also because of a significant proportion of older adult people may present with dementia. Motivating senior citizens with mild cognitive impairment to maintain their independence and functional abilities, improve health status and quality of life as well as social interactions, constitutes the main target of preventive medicine. According to a nudge theoretical approach, the SENIOR (SystEm of Nudge theory based ICT applications for OldeR citizens) project-developed thanks to the collaboration among Catholic University of the Sacred Heart, Bicocca University and IRCCS Auxiologico Institute in Milan (Italy)-has been designed to adopt an advanced information and communication technology coaching system able to collect and integrate physiological, psychological and behavioral data, with the final aim of interacting with community-dwelling elderly people suffering from mild cognitive impairment and of providing them personalized feedback on lifestyle management. The SENIOR project proposes to use a smart-watch app for alerting family doctors, sharing information with family members in specific cases and monitoring patients at higher risk in hospital Units, in order to ameliorate health of senior citizens with mild cognitive impairment.
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Managing cardiac illness is not easy because it dramatically disrupts people's daily life and both the patient and his/her spouse are at risk for experiencing distress, which, in turn, may affect the support provided by the partner as... more
Managing cardiac illness is not easy because it dramatically disrupts people's daily life and both the patient and his/her spouse are at risk for experiencing distress, which, in turn, may affect the support provided by the partner as caregiver. The partner, in fact, is the main source of support, but his/her support may sometimes be inadequate. In addition, dyadic coping (i.e., the way partners cope together against stress and support each other in times of difficulty) could likely be a moderating factor. The main aim of the present study was to examine the role that dyadic coping (DC, in terms of positive, negative, and common dyadic coping responses) plays in moderating the link between patient and partner cardiac illness-related distress (in terms of anxiety and depression) and partner support (in terms of overprotection, hostility, and partner support for patient engagement). The study included 100 married couples faced with cardiac illness who completed a self-report questionnaire. We analyzed our data in PROCESS using multiple regressions in order to assess the moderating effects of DC responses in the relationship between the couple's cardiac illness-related distress and partner support. With regard to patient distress, results showed that higher levels of patient anxiety and depression were linked with ineffective partner support (i.e., overprotection and hostility). With regard to partner distress, higher levels of partner depression were linked with hostility; higher levels of partner depression and anxiety were associated with less partner support for patient engagement. Moreover, the association between distress and partner support was moderated by the quality of DC. In particular, low positive DC represented a risk factor for both the patient and the partner during a cardiac illness, as low positive DC exacerbated the link between patient and partner distress and less effective partner support styles. Also, higher levels of negative DC were risky for couples: The association between distress and less adequate partner supportive behaviors was stronger in the case of higher negative DC. These results imply a need for psychosocial interventions for couples in cardiac illness, especially for couples lacking relational competences, such as positive dyadic coping.
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Eating and weight disorders often develop early in life and cause a long-standing significant health burden. Given the documented role of emotional intelligence (EI) in shaping the body image and predicting the onset of eating disorders,... more
Eating and weight disorders often develop early in life and cause a long-standing significant health burden. Given the documented role of emotional intelligence (EI) in shaping the body image and predicting the onset of eating disorders, knowledge of the mechanisms involved in EI among youth is fundamental to designing specific interventions for screening and prevention of obesity and eating disorders (EDs). The present systematic mapping review was aimed to explore and
quantify the nature and distribution of existing research investigating the impact of EI on EDs in young people. A systematic search for relevant articles was conducted using PubMed, Scopus, PsycINFO and Web of Science databases. The Appraisal tool for Cross-Sectional Studies (AXIS)
was used to assess the included studies’ methodological quality. The included studies’ results were mapped based on stratification by age groups (children, preadolescents, and adolescents), population
(clinical vs. non-clinical) and disordered eating outcomes. Nine studies were included, supporting the association between EI and body image dissatisfaction, ED risk and bulimic symptomatology, but not with anorexic symptoms. Research on children and clinical populations was scant. Further studies are needed to deepen the role of EI in the genesis and maintenance of EDs.
quantify the nature and distribution of existing research investigating the impact of EI on EDs in young people. A systematic search for relevant articles was conducted using PubMed, Scopus, PsycINFO and Web of Science databases. The Appraisal tool for Cross-Sectional Studies (AXIS)
was used to assess the included studies’ methodological quality. The included studies’ results were mapped based on stratification by age groups (children, preadolescents, and adolescents), population
(clinical vs. non-clinical) and disordered eating outcomes. Nine studies were included, supporting the association between EI and body image dissatisfaction, ED risk and bulimic symptomatology, but not with anorexic symptoms. Research on children and clinical populations was scant. Further studies are needed to deepen the role of EI in the genesis and maintenance of EDs.
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Adolescence is a complex developmental phase, made more complex by obesity and the social isolation imposed by the COVID-19 pandemic. The literature related to the impact of social isolation on obesity self-management in adolescents is... more
Adolescence is a complex developmental phase, made more complex by obesity and the social isolation imposed by the COVID-19 pandemic. The literature related to the impact of social isolation on obesity self-management in adolescents is scant and inconsistent. This paper describes the phenomenon from the perspectives of a sample of adolescents with obesity enrolled in an inpa-tients' multidisciplinary rehabilitation program for weight-loss and their caregivers, and its impact on different life domains. Individual semi-structured ad hoc interviews were conducted with 10 adolescent-caregiver dyads, and narratives were qualitatively investigated using an interpretative phenomenology approach to data. Twenty participants took part in the study. The major themes that emerged from this study fall into five basic categories: (1) COVID-19 as an opportunity to reconsider what makes a good life; (2) Persistence in life; (3) Empowering relationship; (4) Daily routine in quarantine; (5) Lives on hold. Understandings drawn from this study may assist health care professionals in providing holistic support, and guidance to adolescents with weight-related issues and their caregivers who experience social isolation during the COVID-19 pandemic.
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Objective: Chronic diseases (CDs) are major causes of deaths, disabilities and healthcare expenditure worldwide. Interventions aimed to prevent or mitigate the impact of CDs need to be added to the traditional healthcare methods. The main... more
Objective: Chronic diseases (CDs) are major causes of deaths, disabilities and healthcare expenditure worldwide. Interventions aimed to prevent or mitigate the impact of CDs need to be added to the traditional healthcare methods. The main purpose of the CHANGE project is the development and validation of a new Nudge theory-based Information and Communications Technology (ICT) coach system for monitoring and empowering patients with CDs. Methods: A randomized controlled clinical trial involving 200 patients with CDs will be implemented. Online assessment of demographic, psychological, neuropsychological, and behavioral outcomes will be carried out through the users' device (smartwatches). A machine learning algorithm-based profile will elaborate specific nudge-based notifications, and suggestions will be returned to participants via the CHANGE App. Expected results: real-time monitoring and tutoring will pre-vent/decelerate the worsening of clinical conditions and will improve the physical and psycho-social health of patients with CDs. Moreover, the provision of tailored care actions will contribute to a more sustainable healthcare system.
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Introduction: The coronavirus (COVID-19) disease has spread worldwide, generating intense fear of infection and death that may lead to enduring anxiety. At the same time, quarantine and physical isolation can intensify feelings of... more
Introduction: The coronavirus (COVID-19) disease has spread worldwide, generating intense fear of infection and death that may lead to enduring anxiety. At the same time, quarantine and physical isolation can intensify feelings of dispositional loneliness that, by focusing on thoughts of disconnection from others, can trigger intense anxiety. Anxiety, generated by both fear of COVID-19 and dispositional loneliness, can activate negative expectations and thoughts of death, potentially generating alarming depressive symptoms. However, the anxiety-buffer hypothesis suggests that self-esteem acts as a shield (buffer) against mental health threats – fear and loneliness – thus hampering anxiety and depressive symptoms. Objective: This study aims to test the process – triggered by COVID-19 fear and loneliness – in which self-esteem should buffer the path leading to anxiety symptoms, then to depression.
Methods: An observational research design with structural equation models was used. A sample of 1200 participants enrolled from the general population answered an online survey comprising: the fear of COVID-19 scale, the UCLA loneliness scale, the Rosenberg self-esteem scale, and the anxiety and depression scales of the Symptom Checklist-90-Revised. Results: Structural equation models showed the link between anxiety symptoms (mediator) with both the fear of COVID-19 and dispositional loneliness (predictors), as well as its association with consequent depressive symptomatology (outcome). In line with the anxiety-buffer hypothesis, self-esteem mediated the relationship between the predictors and their adverse psychological consequences. Conclusion: Self-esteem represents a protective factor from the antecedents of depression. Targeted psychological interventions should be implemented to minimize the psychological burden of the disease whilst promoting adaptation and positive psychological health outcomes.
Methods: An observational research design with structural equation models was used. A sample of 1200 participants enrolled from the general population answered an online survey comprising: the fear of COVID-19 scale, the UCLA loneliness scale, the Rosenberg self-esteem scale, and the anxiety and depression scales of the Symptom Checklist-90-Revised. Results: Structural equation models showed the link between anxiety symptoms (mediator) with both the fear of COVID-19 and dispositional loneliness (predictors), as well as its association with consequent depressive symptomatology (outcome). In line with the anxiety-buffer hypothesis, self-esteem mediated the relationship between the predictors and their adverse psychological consequences. Conclusion: Self-esteem represents a protective factor from the antecedents of depression. Targeted psychological interventions should be implemented to minimize the psychological burden of the disease whilst promoting adaptation and positive psychological health outcomes.
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Single session therapy (SST) postulates that one session can be sufficient for a client to take charge of the process and work toward their own solutions. Research has been conducted worldwide corroborating SST assumptions with several... more
Single session therapy (SST) postulates that one session can be sufficient for a client to take charge of the process and work toward their own solutions. Research has been conducted worldwide corroborating SST assumptions with several mental health conditions, but not in Italy. For the first time in Italy, this paper aims to explore: (1) if the most frequent number of sessions in traditional psychotherapy (not SST) is one (Study 1); and (2) the satisfaction of clients who attend SST services and the number who consider one session sufficient to address their presenting problem (Study 2). In Study 1, the records of 476 voluntary clients referred to three different traditional (not SST) psychological services in the west-central region of Latium, Italy, were retrospectively screened, and the number of sessions attended by each client recorded. In Study 2, 85 consecutive clients who voluntarily asked for SST with seven mental health professionals across Italy received a link to an online ad hoc survey, 1-3 weeks after the consultation, evaluating their experience. Study 1 found that the most frequent number of traditional psychotherapeutic (not intentionally SST) sessions was one (124 out of 476 clients (26%). Study 2 found that 44 out of 85 clients (52%) considered one session to be enough, as they felt better or much better and chose not to attend further sessions. Of those who asked for a second session (41 clients), 33 clients (80.5%) indicated that the first session was not enough and 8 clients (19.5%) wanted to address a new problem. These results converge with previous international studies and provide encouragement for the use of SST in both private and public psychological services to address the demand for timely mental health services in Italy. Further research is needed to support the efficacy of SST and to evaluate its cost-effectiveness.
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Objective: Informal care, defined as the unpaid care provided to an older, frail or ill person, by a person such as a spouse, parent, child, other relative, neighbour, friend, may lead to stress, burden and low well-being levels. As the... more
Objective: Informal care, defined as the unpaid care provided to an older, frail or ill person, by a person such as a spouse, parent, child, other relative, neighbour, friend, may lead to stress, burden and low well-being levels. As the phenomenon of informal care is growing, there is a need of psychological interventions in order to support informal caregivers. Evidence-based psychological treatments obtained good results in terms of well-being, but access to these treatments could be difficult for caregivers due to the of lack of time and financial strains. Internet-based interventions could be a possible solution within this scenario. "SOSteniamoci", an Internet-based Cognitive Behavioral Treatment program, consisting of 8 modules, will be adapted and tested in Italy. Methods: A randomized controlled clinical trial involving 128 informal caregivers will be conducted. Participants will be recruited from the Istituto Auxologico Italiano IRCCS 1 and social media advertisements. After initial screening they will be randomly assigned to either an experimental group or a waiting list group. Expected results: During the last decade, internet-based cognitive behavioral interventions have been developed and tested. This therapeutic approach, due to its characteristics, could be beneficial in supporting informal caregivers. We expect this intervention to be feasible and efficient in reducing caregivers' burden, anxiety, depression and stress, while improving caregivers' quality of life and the quality of relationship with the care receiver.
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The arrival of the coronavirus (COVID-19) pandemic has confronted us with a global and unprecedented challenge of community-wide psychological distress alongside reduced access to therapeutic services in the traditional face-to-face... more
The arrival of the coronavirus (COVID-19) pandemic has confronted us with a global and unprecedented challenge of community-wide psychological distress alongside reduced access to therapeutic services in the traditional face-to-face format, due to the need to self-isolate. This previously unimagineable set of circumstances provides a unique opportunity, and indeed an imperative, for videotherapy to fulfil its potential in addressing mental health and well-being needs from a distance. Historically, the uptake of videotherapy has been hindered by psychotherapist expectations of inferior therapeutic alliance and outcomes, in spite of considerable research evidence to the contrary. Research suggests that videotherapy provides a powerful pathway for clients to experience enhanced opportunities for self-expression, connection and intimacy. This more neutral therapeutic 'space' provides clients with multifarious opportunities for self-awareness, creative experience and collaboration, with potentially a greater sense of agency over their own experience. This paper explores ways in which videotherapy can lead to a revitalisation of the concept of the therapeutic relationship, in order to meet the challenges associated with COVID-19. A number of specific considerations for videotherapy adaptations and etiquette in the midst of COVID-19 are described.
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This provisional PDF corresponds to the article as it appeared upon acceptance. A copyedited and fully formatted version will be made available soon. The final version may contain major or minor changes. Subscription: Information about... more
This provisional PDF corresponds to the article as it appeared upon acceptance. A copyedited and fully formatted version will be made available soon. The final version may contain major or minor changes. Subscription: Information about subscribing to Minerva Medica journals is online at: http://www.minervamedica.it/en/how-to-order-journals.php Reprints and permissions: For information about reprints and permissions send an email to: journals.dept@minervamedica.it-journals2.dept@minervamedica.it
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Keywords: invariance body image drive for leanness drive for muscularity body change strategies a b s t r a c t The aim of this study was to examine the crosscountry invariance of five well-established measures of body weight and shape... more
Keywords: invariance body image drive for leanness drive for muscularity body change strategies a b s t r a c t The aim of this study was to examine the crosscountry invariance of five well-established measures of body weight and shape concern-related attitudes and behaviors (i.e., drive for leanness, drive for muscularity, strategies to increase muscle, strategies to lose weight, and weight and shape concerns). A secondary objective was to examine the effects of several sociodemographic factors (age, BMI, socioeconomic status, and gender) on item and latent factor scores of these constructs. A total of 6272 emerging adults (4218 women; M age = 21.46, SD = 3.11) from Australia, and the U.S. completed a self-report online survey as part of a larger study. Overall, support for partial invariance both across countries and in terms of the considered sociodemographic factors was found for reduced versions of the five measures. Significant differences in latent means were found across countries , these being of greater magnitude for drive for leanness and strategies to lose weight. The considered sociodemographic factors (most notably BMI and gender) were associated with the latent mean scores of (M. Caltabiano), m.alcaraz@ual.es (M. Alcaraz-Ibánez). A. Sicilia et al. Body Image 35 (2020) 288-299 the assessed constructs. The present study contributes to current literature by providing cross-cultural invariant versions of several measures of relevance in the field of body image.
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The aim of the current study was to examine the psychometric properties of two well-established measures of sociocultural influence and internalization of the thin/low body fat ideal and muscular ideal. Data from 6272 emerging adults... more
The aim of the current study was to examine the psychometric properties of two well-established measures of sociocultural influence and internalization of the thin/low body fat ideal and muscular ideal. Data from 6272 emerging adults (68.9 % female), aged 18-30 years from Australia, and the U.S. were included in this study. Participants completed measures of pressure from mother, fathers, peers, and media, to both increase muscles and lose weight, as well as internalization of the thin/low body fat ideal and muscular ideal. Overall, support for partial invariance was found across the scales. In addition, group level differences were found between countries as well as along demographic factors including gender, age, body mass index, and socioeconomic status. These findings make an important contribution by identifying these scales as useful tools that will support future crosscountry and cross-cultural examinations of explanatory models of the development of body image and eating concerns grounded within sociocultural theories.
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This study assessed the measurement invariance of selected self-report measures of perfectionism, impulsivity, self-esteem and social anxiety in samples of emerging adults from eight different countries. Participants (N = 6272) completed... more
This study assessed the measurement invariance of selected self-report measures of perfectionism, impulsivity, self-esteem and social anxiety in samples of emerging adults from eight different countries. Participants (N = 6272) completed the Multidimensional Perfectionism Scale (MPS), the UPPS-P Impulsive Behavior Scale, the 5-item Rosenberg Self-Esteem Scale (5-item RSES) and the Social Interaction Anxiety Scale (SIAS-6). Multigroup confirmatory factor analysis was run to examine cross-measure equivalence. Evidence for structural invariance was found for all questionnaires, while weak invariance was supported only for the 5-item RSES and the SIAS-6, and a partial weak invariance was found for the MPS and the UPPS-P. No measure achieved strong invariance. Strict invariance was achieved for the 5-item RSES, whereas only a partial strict invariance was supported for the MPS, UPPS-P and SIAS-6. These results suggest that perfectionism, impulsivity, self-esteem, and social anxiety are subjected to linguistic/cultural influence as well as to the effects of socio-demographic variables and can be evaluated by using the selected measures in eight different countries worldwide-but results should be interpreted with caution.
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Positive body image refers to individuals' ability to conceptualize their bodies with love, respect, and appreciation. The study of positive body image is relatively new, and instruments used to investigate this multi-faceted construct... more
Positive body image refers to individuals' ability to conceptualize their bodies with love, respect, and appreciation. The study of positive body image is relatively new, and instruments used to investigate this multi-faceted construct have received limited use in non-English speaking countries. Thus, the aim of this investigation is to consider four measures that are associated with positive body image across eight different countries. Participants (n = 6272) completed the Body Appreciation Scale-2, the Body Areas Satisfaction Scale, the Physical Appearance Comparison Scale, and the Weight Bias Internalization Scale. Multi-group confirmatory factor analyses (MG-CFAs) and item-response theory (IRT) models were used to examine the measurement invariance of these surveys. Our results generally suggest that positive body image, weight bias, and appearance comparison can be assessed using brief assessments and that these four instruments can be used in different countries, but care should be taken to consider individuals' gender, BMI, and socioeconomic position.
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Many individuals presenting to medical settings with heart-related symptoms for which no medical explanation is found might suffer from cardiophobia, but this condition is still poorly identified and addressed. This article presents a... more
Many individuals presenting to medical settings with heart-related symptoms for which no medical explanation is found might suffer from cardiophobia, but this condition is still poorly identified and addressed. This article presents a case of car-diophobia treated in an outpatient cardiac rehabilitation unit and, for the first time, describes the application of brief strategic therapy for the treatment of this condition. In the case reported, the first therapeutic encounter and the key elements of the strategic approach are described in detail with the aim to explain how brief strategic therapy works and how it can be used to identify and address cardiophobia-related behaviors. A 64-year-old male presented to cardiac rehabilitation reporting intense anxiety-provoking heart palpitations, and believing he was at risk of dying from a heart attack. After 3 sessions, an overall improvement in heart-related bodily sensations followed a decrease in the patient's continuous checking of his heartbeat and seeking reassurance-factors that were largely responsible for the persistence of the problem. Moreover, quantitative evaluation showed increased scores of mood state at the end of treatment. This improvement persisted at the 18-month follow-up. This case is an interesting example of how brief strategic therapy can contribute to the development of a new conceptual model for the diagnosis and treatment of cardiophobia. Still, more systematic research in the field is needed to prove the efficacy and effectiveness of this therapeutic approach on symptoms of heart-focused anxiety.
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Perceived social isolation during the COVID-19 pandemic significantly has had an extraordinary global impact, with significant psychological consequences. Changes in our daily lives, feeling of loneliness, job losses, financial... more
Perceived social isolation during the COVID-19 pandemic significantly has had an extraordinary global impact, with significant psychological consequences. Changes in our daily lives, feeling of loneliness, job losses, financial difficulty, and grief over the death of loved ones have the potential to affect the mental of many. In an atmosphere of uncertainty, it is essential that clear and precise information is offered about the problem and how to manage it. In this contribution, a rationale is provided for an urgent call for a rapid response to the mental health impacts of COVID-19. Moreover, suggestions for individuals to regulate their emotions effectively and appropriately are provided.
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Objective: To develop and test the factorial structure of a new self-determination theory-based measure of behavioral regulation in children. Methods: Five hundred ninety 590 (F = 51.7%) children aged 7 to 11 years completed the... more
Objective: To develop and test the factorial structure of a new self-determination theory-based measure of behavioral regulation in children. Methods: Five hundred ninety 590 (F = 51.7%) children aged 7 to 11 years completed the Motivation to Exercise and Diet (MED-C) questionnaire, which comprises 16 items (eight for exercise and eight for diet) grouped into eight factors (five motivations and three needs). Psychometric testing included confirmatory factor analysis and internal consistency. Measurement invariance analyses were also performed to evaluate whether the factorial structure of the MED-C was equivalent for gender (male vs. female), age (≤9 vs. ≥10 years), and the perception of having at least one parent with overweight or obesity (yes vs. no). Results: Factorial analysis confirmed an acceptable factors solution for the MED-C and a good fit to the data for both the exercise and the diet subscales assessed independently. The maximal reliability coefficient revealed good reliability for the exercise and the diet subscales. Moreover, the MED-C factor structure was invariant across group comparisons. Discussion: Findings support the construct validity and reliability of the MED-C. Therefore, it represents the first validated instrument simultaneously measuring motivational regulation and psychological need satisfaction in the context of children's exercise and diet. Considering the goodness of these results, scale percentile ranks of the total score distribution as well as the z score and the T score were provided for clinical and research purposes. Conclusion: The MED-C might support the understanding of motivations and needs of children with weight problems and assist their process of behavioral change in primary and secondary prevention programs. Psychological factors represent, in fact, potential targets for interventions to increase children's motivation to exercise and diet.
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Conscious and functional use of online social spaces can support the elderly with mind cognitive impairment (MCI) in their daily routine, not only for systematic monitoring, but to achieve effective targeted engagement. In this sense,... more
Conscious and functional use of online social spaces can support the elderly with mind cognitive impairment (MCI) in their daily routine, not only for systematic monitoring, but to achieve effective targeted engagement. In this sense, although social involvement can be obtained when elder's experiences, interests, and goals are shared and accepted by the community, an important subsistence for aging depends on the compelling information, users' cooperation , and resource reliability. Unfortunately, applications aimed at optimizing the information content and the reliability of online users are still missing. Within the SystEm of Nudge theory-based ICT applications for OldeR citizens (SENIOR) project, an advanced social platform will be created in which the elderly with MCI will be involved in "optimized" social communities, where suggestions for general well-being will be recognized as useful by users and shared by care providers. We report the results of our study addressing this issue from a theoretical perspective: we propose a computational problem and a heuristic solution where "expert users" can engage and support the elderly by suggesting available services and facilities for their conditions. The numerical experiments on synthetic data are of interest when considering large communities, which is the most natural situation for online social spaces.
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Background: There is a high prevalence of children and young people (CYP) experiencing mental health (MH) problems. Owing to accessibility, affordability, and scalability, an increasing number of digital health interventions (DHIs) have... more
Background: There is a high prevalence of children and young people (CYP) experiencing mental health (MH) problems. Owing to accessibility, affordability, and scalability, an increasing number of digital health interventions (DHIs) have been developed and incorporated into MH treatment. Studies have shown the potential of DHIs to improve MH outcomes. However, the modes of delivery used to engage CYP in digital MH interventions may differ, with implications for the extent to which findings pertain to the level of engagement with the DHI. Knowledge of the various modalities could aid in the development of interventions that are acceptable and feasible.
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Objective: Exercise capacity (EC) is a well-established predictor of cardiovascular health. It is notoriously influenced by several factors, but the independent effect of psychological well-being (PWB) on EC has not yet been explored. The... more
Objective: Exercise capacity (EC) is a well-established predictor of cardiovascular health. It is notoriously influenced by several factors, but the independent effect of psychological well-being (PWB) on EC has not yet been explored. The present study aims to investigate (1) whether PWB is an independent predictor of EC over and above selected demographic, behavioral, and biomedical parameters in a sample of CR patients with obesity and (2) whether PWB is a stronger predictor of EC than the other variables. Methods: Data from 1968 patients were collected at the time of their inclusion in a cardiac rehabilitation (CR) program and retrospectively analyzed in a cross-sectional study. Since cardiorespiratory parameters defined in normal weight populations differ from those of their obese counterparts, an ad hoc validated formula taking body mass index (BMI) into consideration was used to predict EC. Results: A multiple regression analysis revealed left ventricular eject fraction (LVEF) to be the strongest predictor of EC, followed by PWB, type 2 diabetes (DM), smoking status, atrial fibrillation (AF), and education. Bayesian evaluation of informative hypotheses corroborated LVEF as the best predictor of EC, and confirmed the superiority of PWB over and above DM and smoking status in influencing EC. Conclusion: These findings strengthen the link between psychological and physical health, suggesting a better PWB is associated with greater EC. Prompt screening of a patient's mood and readiness to perform an active lifestyle would therefore enhance the long-term health benefits of CR.
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Purpose This study was aimed to examine the psychometric proprieties of the Body Image Quality of Life Inventory (BIQLI) among Brazilian, Portuguese, Mozambican, and Italian college students. Methods A total of 1630 subjects (Brazilians =... more
Purpose This study was aimed to examine the psychometric proprieties of the Body Image Quality of Life Inventory (BIQLI) among Brazilian, Portuguese, Mozambican, and Italian college students. Methods A total of 1630 subjects (Brazilians = 446; Portuguese = 480, Mozambicans = 360, and Italians = 344) completed the Portuguese (Brazilian, Portuguese, and Mozambican students) and the Italian versions (Italian students) of the BIQLI for measuring the effects of body image on one's quality of life. Psychometric testing included confirmatory factor analysis (CFA), discriminant and convergent validity, internal consistency, and composite reliability. The cross-national invariance of the BIQLI was assessed by multi-group analysis using ΔCFI. Moreover, the global score of the BIQLI for all countries was calculated by an algorithm and compared using the Welch's ANOVA and the Games-Howell post-test (α = 5%). Results CFA showed an inadequate fit of unifactorial model of the BIQLI. Therefore, an alternative model comprising nine first-order factors and one second-order factor was proposed and evaluated. This new model showed adequate fit in all samples , despite some limitations that were found with respect to its convergent and discriminant validity. The alternative BIQLI model was invariant among countries. Global scores for the influence of body image on quality of life were significantly different across countries, with the Italians presenting the lowest scores. Conclusions The BIQLI factorial model found in this study represents a reliable and valid alternative to its original structure for the assessment of the effect of body image on college students' perceived quality of life. This model must be further tested in other populations. Level of evidence Level V, cross-sectional descriptive study.
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Background: Although cognitive behavioral therapy is the gold standard treatments for bulimia nervosa (BN) and binge eating disorder (BED), evidence for its long-term efficacy is weak. Empirical research support the efficacy of brief... more
Background: Although cognitive behavioral therapy is the gold standard treatments for bulimia nervosa (BN) and binge eating disorder (BED), evidence for its long-term efficacy is weak. Empirical research support the efficacy of brief strategic therapy (BST) in treating BN and BED symptoms, but its statistical significance still need to be investigated. Objective: To statistically test the long-term efficacy of the BST treatment protocols for BN and BED through one-year post-treatment. Methods: A two-group longitudinal study will be conducted. Participants will be sequentially recruited for inclusion in a state-funded community psychotherapy clinic. Multilevel growth curve modeling will be used to estimate the average growth trajectories from baseline to one year after treatment termination for the severity of the BN and BED features as measured by the Eating Disorder Examination Questionnaire. Discussion: Findings from this study will clarify the impact of BST in treating BN and BED symptoms. Conclusion: Translating research into practice may inform how to ensure high-quality patient care.
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The widespread of overweight and obesity in the developed countries is a real societal issue, nevertheless a considerable amount of subjects with obesity do not recognize their condition. Researchers used different methods to assess body... more
The widespread of overweight and obesity in the developed countries is a real societal issue, nevertheless a considerable amount of subjects with obesity do not recognize their condition. Researchers used different methods to assess body size perception by obese subjects and the results show that while some subjects with obesity estimate accurately or overestimate their body size, others underestimate their weight and their body size measures. A failure to identify overweight or obesity has serious consequences on the subject's health, as it is widely recognised that self-awareness is the first step to engage in a rehabilitation program. The spread of obesity underestimation and its implications make the case for a new hypothetical body image disorder, which has been called Fatorexia™. It consists in the significant underestimation of body size by subjects with obesity, as they are unable or unwilling to acknowledge their condition. Some researchers proposed a social explanation to the underestimation phenomenon, but here an alternative hypothesis, the Allocentric Lock Theory (ALT), is outlined to describe the mechanisms behind the underestimation of body size by subjects with obesity. Keywords: obesity, body image, body size perception, body size underestimation, fatorexia ¿Los sujetos con obesidad subestiman su tamaño corporal? Una revisión narrativa de los métodos de estimación y teorías explicativas RESUMEN: La generalización del sobrepeso y la obesidad en los países desarrollados es un verdadero problema social, sin embargo, una cantidad considerable de personas con obesidad no reconocen su condición. Los investigadores utilizaron diferentes métodos para evaluar la percepción del tamaño corporal de los sujetos obesos y los resultados muestran que mientras que algunos sujetos con obesidad calculan con precisión o sobreestiman su tamaño corporal, otros subestiman su peso y sus medidas de tamaño corporal. El hecho de no identificar el sobrepeso o la obesidad tiene graves consecuencias para la salud del sujeto, ya que se reconoce ampliamente que la autoconciencia es el primer paso para participar en un programa de rehabilitación. La propagación de la subestimación de la obesidad y sus implicaciones hacen que se presente el caso de un nuevo trastorno hipotético de la imagen corporal, el cual se ha denominado Fatorexia™. Esta consiste en la subestimación significativa del tamaño del cuerpo por parte de los sujetos con obesidad, ya que no pueden o no quieren reconocer su condición.
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The term drunkorexia refers to the act of self-imposed utilization of extreme weight control methods to compensate for alcohol consumption typically observed among university students. Despite its diffusion, there is a lack of research... more
The term drunkorexia refers to the act of self-imposed utilization of extreme weight control methods to compensate for alcohol consumption typically observed among university students. Despite its diffusion, there is a lack of research investigating the presence of this new alarming trend in Italy. Aim: this study estimates the frequency of drunkorexia behaviours in a sample of Italian youth aged 14-24, explores the motivations for alcohol consumption among those presenting drunkorexia-type behaviours, and examines the relationship between drunkorexia and disordered eating. Methods: drunkorexia behaviors, eating habits and motives for alcohol use were investigated in 403 subjects (F=301, M=102) aged 14-24 through self-report questionnaires. A series of analyses, including descriptive statistics, univariate analysis of the variance and multiple regressions were run. Results: 62.5% of the sample showed drunkorexia-type behaviours. Drunkorexia was related to disordered eating, especially among females older than eighteen. Discussion and Conclusions: this the first study investigating the incidence of drunkorexia behaviors in a sample of youth living in Northern Italy. Evidence-based interventions for eating disorders and drinking problems should inspire the development of ad hoc preventive and treatment actions for drunkorexia.
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Background: Obesity and the state of being overweight are increasing steadily and becoming a global epidemic. Recent research reports 64% of the adult population as overweight in Europe and the USA. The social and economic impacts are... more
Background: Obesity and the state of being overweight are increasing steadily and becoming a global epidemic. Recent research reports 64% of the adult population as overweight in Europe and the USA. The social and economic impacts are increasing, and most of the rehabilitation programs, while effective in the short term, do not produce long-lasting results. An explanatory model from a behavioral perspective can describe the phenomena with the lack of sources of reinforcement related to healthful habits in a daily life context.
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Objective: Binge eating disorder (BED) is frequently linked with obesity and related health risks like cardiovascular disease and diabetes. The purpose of this randomized clinical trial (RCT) was to determine the effectiveness of brief... more
Objective: Binge eating disorder (BED) is frequently linked with obesity and related health risks like cardiovascular disease and diabetes. The purpose of this randomized clinical trial (RCT) was to determine the effectiveness of brief strategic therapy (BST) compared with cognitive-behavioral therapy (CBT) 1 year after a two-phase inpatient and outpatient-telemedicine treatment for BED. Method: Italian women with BED and comorbid obesity were recruited from a self-referred inpatient treatment program for weight loss (N 60) and randomly assigned to either the BST treatment condition (n 30) or CBT treatment condition (n 30). Inpatient psychotherapy sessions were conducted in person and outpatient telemedicine psychotherapy sessions were conducted over the telephone. Multilevel growth curve modeling was used to estimate average growth trajectories from baseline to 1 year after treatment for the following outcomes: binge eating frequency, weight, and global functioning. Results: One year after treatment, women in the BST condition decreased in binge eating frequency and women in the CBT condition did not, whereas women in both conditions improved in weight and global functioning. BST was statistically and clinically superior to CBT in improving binge eating frequency, weight, and global functioning. Conclusions: Examining BED, given the current obesity epidemic, is an important area of study. Findings suggest that BST is statistically and clinically more effective than CBT in treating BED, promoting weight loss, and improving global functioning among women with BED and comorbid obesity 1 year after treatment. Telemedicine may be instrumental in reducing attrition.
Research Interests:
Research Interests:
Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be... more
Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurolog-ical disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use.
Research Interests:
Objective: The aim of this study was to examine the psychometric properties and factorial structure of the Schema Mode Inventory for Eating Disorders (SMI-ED) in a disordered eating population. Method: 573 participants with disordered... more
Objective: The aim of this study was to examine the psychometric properties and factorial structure of the Schema Mode Inventory for Eating Disorders (SMI-ED) in a disordered eating population. Method: 573 participants with disordered eating patterns as measured by the Eating Disorder Examination Questionnaire (EDE-Q) completed the 190-item adapted version of the Schema Mode Inventory (SMI). The new SMI-ED was developed by clinicians/researchers specializing in the treatment of eating disorders, through combining items from the original SMI with a set of additional questions specifically representative of the eating disorder population. Psychometric testing included Confirmatory Factor Analysis (CFA) and internal consistency (Cronbach's α). Multivariate Analyses of Covariance (MANCOVA) was also run to test statistical differences between the EDE-Q subscales on the SMI-ED modes, while controlling for possible confounding variables. Results: Factorial analysis confirmed an acceptable 16-related-factors solution for the SMI-ED, thus providing preliminary evidence for the adequate validity of the new measure based on internal structure. Concurrent validity was also established through moderate to high correlations on the modes most relevant to eating disorders with EDE-Q subscales. This study represents the first step in creating a psychometrically sound instrument for measuring schema modes in eating disorders, and provides greater insight into the relevant schema modes within this population. Conclusion: This research represents an important preliminary step toward understanding and labeling the schema mode model for this clinical group. Findings from the psychometric evaluation of SMI-ED suggest that this is a useful tool which may further assist in the measurement and conceptualization of schema modes in this population.
Research Interests:
Research Interests:
Research Interests:
Background: Weight loss is challenging and maintenance of weight loss is problematic. Web-based programs offer good potential for delivery of interventions for weight loss or weight loss maintenance. However, the precise impact of... more
Background: Weight loss is challenging and maintenance of weight loss is problematic. Web-based programs offer good potential for delivery of interventions for weight loss or weight loss maintenance. However, the precise impact of Web-based weight management programs is still unclear.
Objective: The purpose of this meta-systematic review was to provide a comprehensive summary of the efficacy of Web-based interventions for weight loss and weight loss maintenance.
Methods: Electronic databases were searched for systematic reviews and meta-analyses that included at least one study investigating the effect of a Web-based intervention on weight loss and/or weight loss maintenance among samples of overweight and/or obese individuals. Twenty identified reviews met the inclusion criteria. The Revised Assessment of Multiple SysTemAtic
Reviews (R-AMSTAR) was used to assess methodological quality of reviews. All included reviews were of sufficient
methodological quality (R-AMSTAR score ≥22). Key methodological and outcome data were extracted from each review.
Results: Web-based interventions for both weight loss and weight loss maintenance were more effective than minimal or control conditions. However, when contrasted with comparable non-Web-based interventions, results were less consistent across reviews.
Conclusions: Overall, the efficacy of weight loss maintenance interventions was stronger than the efficacy of weight loss interventions, but further evidence is needed to more clearly understand the efficacy of both types of Web-based interventions.
Objective: The purpose of this meta-systematic review was to provide a comprehensive summary of the efficacy of Web-based interventions for weight loss and weight loss maintenance.
Methods: Electronic databases were searched for systematic reviews and meta-analyses that included at least one study investigating the effect of a Web-based intervention on weight loss and/or weight loss maintenance among samples of overweight and/or obese individuals. Twenty identified reviews met the inclusion criteria. The Revised Assessment of Multiple SysTemAtic
Reviews (R-AMSTAR) was used to assess methodological quality of reviews. All included reviews were of sufficient
methodological quality (R-AMSTAR score ≥22). Key methodological and outcome data were extracted from each review.
Results: Web-based interventions for both weight loss and weight loss maintenance were more effective than minimal or control conditions. However, when contrasted with comparable non-Web-based interventions, results were less consistent across reviews.
Conclusions: Overall, the efficacy of weight loss maintenance interventions was stronger than the efficacy of weight loss interventions, but further evidence is needed to more clearly understand the efficacy of both types of Web-based interventions.
Research Interests:
Abstract: Obesity is a chronic condition associated with risk factors for many medical complications and comorbidities such as cardiovascular diseases, some types of cancer, osteoarthritis, hypertension, dyslipidemia,... more
Abstract: Obesity is a chronic condition associated with risk factors for many medical complications and comorbidities such as cardiovascular diseases, some types of cancer, osteoarthritis, hypertension, dyslipidemia, hypercholesterolemia, type-2 diabetes, obstructive sleep apnea syndrome, and different psychosocial issues and psychopathological disorders. Obesity is a highly complex, multifactorial disease: genetic, biological, psychological, behavioral, familial,
social, cultural, and environmental factors can influence in different ways. Evidence-based strategies to improve weight loss, maintain a healthy weight, and reduce related comorbidities typically integrate different interventions: dietetic, nutritional, physical, behavioral, psychological, and if necessary, pharmacological and surgical ones. Such treatments are implemented in
a multidisciplinary context with a clinical team composed of endocrinologists, nutritionists, dietitians, physiotherapists, psychiatrists, psychologists, and sometimes surgeons. Cognitive behavioral therapy (CBT) is traditionally recognized as the best established treatment for binge eating disorder and the most preferred intervention for obesity, and could be considered as the first-line treatment among psychological approaches, especially in a long-term perspective; however, it does not necessarily produce a successful weight loss. Traditional CBT for weight
loss and other protocols, such as enhanced CBT, enhanced focused CBT, behavioral weight loss treatment, therapeutic education, acceptance and commitment therapy, and sequential binge, are discussed in this review. The issue of long-term weight management of obesity, the real challenge in outpatient settings and in lifestyle modification, is discussed taking into account
the possible contribution of mHealth and the stepped-care approach in health care
social, cultural, and environmental factors can influence in different ways. Evidence-based strategies to improve weight loss, maintain a healthy weight, and reduce related comorbidities typically integrate different interventions: dietetic, nutritional, physical, behavioral, psychological, and if necessary, pharmacological and surgical ones. Such treatments are implemented in
a multidisciplinary context with a clinical team composed of endocrinologists, nutritionists, dietitians, physiotherapists, psychiatrists, psychologists, and sometimes surgeons. Cognitive behavioral therapy (CBT) is traditionally recognized as the best established treatment for binge eating disorder and the most preferred intervention for obesity, and could be considered as the first-line treatment among psychological approaches, especially in a long-term perspective; however, it does not necessarily produce a successful weight loss. Traditional CBT for weight
loss and other protocols, such as enhanced CBT, enhanced focused CBT, behavioral weight loss treatment, therapeutic education, acceptance and commitment therapy, and sequential binge, are discussed in this review. The issue of long-term weight management of obesity, the real challenge in outpatient settings and in lifestyle modification, is discussed taking into account
the possible contribution of mHealth and the stepped-care approach in health care
Research Interests:
The MOTIV-HEART study is aimed at testing the incremental efficacy of Brief Strategic Therapy (BST) combined with Motivational Interviewing (MI) in improving selected biomedical and psychological outcomes over and beyond the stand-alone... more
The MOTIV-HEART study is aimed at testing the incremental efficacy of Brief Strategic Therapy (BST) combined with Motivational Interviewing (MI) in improving selected biomedical and psychological outcomes over and beyond the stand-alone BST in Cardiac Rehabilitation (CR). 42 heart patients referring to a single clinical center for CR and weigh loss treatment were randomly allocated into two conditions: i) 3 sessions of BST; ii) 3 sessions of BST plus MI. Data were collected at baseline and discharge (1 month later). Pre-treatment heterogeneity was found between groups, and no significant between-group difference in post-treatment medians was obtained in any variables. Within-group changes were detected for the patients' extrinsic regulation, which significantly decreased only in the BST group, and for the RAI score and the patients' willingness to change, significantly increasing only in the control group. No evidence of superiority of the combined treatment (BST +MI) over stand-alone BST within CR was found. Conclusions: since combining BST and MI within CR for the first time, the present investigation sets out to be a pilot study, and its results can therefore guide in the implementation of stronger experimental design that would help clarifying the obtained outcomes.
Research Interests:
Background: Psychological distress, biomedical parameters, and unhealthy lifestyles contribute to a poorer prognosis for cardiac disease. Public health’s challenge is to motivate patients to utilize self-care. Objective: This prospective,... more
Background: Psychological distress, biomedical parameters, and unhealthy lifestyles contribute to a poorer prognosis for cardiac disease. Public health’s challenge is to motivate patients to utilize self-care.
Objective: This prospective, randomized, single-blind pilot study aimed at testing the incremental efficacy of Brief Strategic Therapy (BST) combined with Motivational Interviewing (MI) in improving selected biomedical and psychological outcomes over and beyond those of the stand-alone BST in a residential Cardiac Rehabilitation (CR) program.
Method: Fourty-two inpatients (17 females), enrolled in a 1-month CR program, were randomly allocated into two conditions: (a) Three sessions of BST and (b) Three sessions of BST plus MI. Data were collected at baseline, discharge, and after 3 months through
phone interviews.
Results: At discharge, no significant between-group difference was found in any outcome variable. Changes from pre- to post-treatment within each condition showed significant improvements only in the BST group, where the level of external regulation diminished, and both the participants’ self-regulation (Relative Autonomous Motivation Index, RAI) and willingness to change improved. At the 3-month follow-up, within-group analyses on responders (BST = 9; BST + MI = 11) showed a statistically significant improvement in the level of systolic blood pressure in both groups.
Discussion: Findings showed no evidence of the incremental efficacy of combining BST and MI over and beyond BST alone on either selected biomedical or psychological outcomes among CR patients.
Conclusions: Ends and limitations from the present pilot study should be considered and addressed in future investigations.
Objective: This prospective, randomized, single-blind pilot study aimed at testing the incremental efficacy of Brief Strategic Therapy (BST) combined with Motivational Interviewing (MI) in improving selected biomedical and psychological outcomes over and beyond those of the stand-alone BST in a residential Cardiac Rehabilitation (CR) program.
Method: Fourty-two inpatients (17 females), enrolled in a 1-month CR program, were randomly allocated into two conditions: (a) Three sessions of BST and (b) Three sessions of BST plus MI. Data were collected at baseline, discharge, and after 3 months through
phone interviews.
Results: At discharge, no significant between-group difference was found in any outcome variable. Changes from pre- to post-treatment within each condition showed significant improvements only in the BST group, where the level of external regulation diminished, and both the participants’ self-regulation (Relative Autonomous Motivation Index, RAI) and willingness to change improved. At the 3-month follow-up, within-group analyses on responders (BST = 9; BST + MI = 11) showed a statistically significant improvement in the level of systolic blood pressure in both groups.
Discussion: Findings showed no evidence of the incremental efficacy of combining BST and MI over and beyond BST alone on either selected biomedical or psychological outcomes among CR patients.
Conclusions: Ends and limitations from the present pilot study should be considered and addressed in future investigations.
Research Interests:
P ain is frequent in patients undergoing neurorehabilitation, but there is a number of still unanswered questions on this topic. The Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN ) was constituted with the purpose to... more
P
ain is frequent in patients undergoing neurorehabilitation, but there is a number of still unanswered questions on this topic. The Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN ) was constituted with the purpose to identify the best practices that can be used in this context. In this article we summarize the existing evidence and recommendations provided by the ICCPN about the role of gender, psycho-social factors and anthropological-cultural dimensions on pain in neurorehabilitation. Sex, gender, psycho-social variables, anthropological and cultural features may influence pain expression, and its pharmacological and non-pharmacological outcome, but the role of these factors has not been consistently explored in neurorehabilitation. There is a number of psychological factors that can be correlated with or represent a predictor for pain, or may influence the treatment and outcome of neurorehabilitation programs. All these factors should be considered when designing these programs, and future studies should incorporate them as potential covariates that may influence outcome.
ain is frequent in patients undergoing neurorehabilitation, but there is a number of still unanswered questions on this topic. The Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN ) was constituted with the purpose to identify the best practices that can be used in this context. In this article we summarize the existing evidence and recommendations provided by the ICCPN about the role of gender, psycho-social factors and anthropological-cultural dimensions on pain in neurorehabilitation. Sex, gender, psycho-social variables, anthropological and cultural features may influence pain expression, and its pharmacological and non-pharmacological outcome, but the role of these factors has not been consistently explored in neurorehabilitation. There is a number of psychological factors that can be correlated with or represent a predictor for pain, or may influence the treatment and outcome of neurorehabilitation programs. All these factors should be considered when designing these programs, and future studies should incorporate them as potential covariates that may influence outcome.
The interplay between pain and neurorehabilitation is very complex, in that pain may be a target for treatment, but can also have negative effects on neurorehabilitation procedures. Moreover, side effects of drugs, which are currently... more
The interplay between pain and neurorehabilitation is very complex, in that pain may be a target for treatment, but can also have negative effects on neurorehabilitation procedures. Moreover, side effects of drugs, which are currently used to treat pain, may negatively influence rehabilitation outcomes. Because of the lack of guidelines or consensus, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) was aimed to answer some open questions on the treatment of pain in this setting. To this aim, we collected evidence on the pharmacological and non-pharmacological strategies and their role in the integrated approach to pain. Despite the lack of studies in patients undergoing neurorehabilitation, current guidelines on the pharmacological treatment of nociceptive and neuropathic pain may be applied in this setting. Non-pharmacological strategies include physical therapy, invasive procedures, psychological treatments and psychotherapy, which together with pharmacological therapies play a key role in the integrated approach to pain. The ICCPN recommendations offer information to ameliorate the current treatment of pain in neurorehabilitation, and to design future studies to answer the still open questions on this topic.
Research Interests:
Objective: In this article, we investigate therapist views on their experiences using a technological adjunct (goACT) to traditional, face-to-face psychotherapy. goACT is a web-based mobile interactive software application that... more
Objective: In this article, we investigate therapist views on their experiences using a technological adjunct (goACT) to traditional, face-to-face psychotherapy. goACT is a web-based mobile interactive software application that facilitates an interactive platform, allowing therapists to connect with their clients between face-to-face psychotherapy sessions. Method: Participants were six provisional psychologists and seven patients. Data were collected at two post-therapy focus groups in order to qualitatively understand therapist experience of goACT as a therapy adjunct. Data were analysed utilising thematic analysis. Results: Four main themes emerged: (1) " discretional use of goACT " linked to therapist preferences and client suitability; (2) " therapist concerns " linked to boundaries, workload, technological glitches, and therapeutic risks; (3) " goACT expands the parameters of therapy " through increased opportunities to provide care and connection with patients and increased access to the process of therapy; and (4) " goACT enhances therapy " through reciprocal responsibility and guided empowerment. Therapists in this study were more open to the use of technology in therapy than has been reported in previous research and did not find that it affected their workload. Conclusion: Therapists indicated that when aligned to the specific needs of individual patients, an advanced mobile and web-based interactive software application (goACT) has the potential to enhance engagement, rapport, and patient empowerment in face-to-face psychotherapy.
Research Interests:
Objective: Anecdotal claims insinuate that female Australian university students may be engaging in a new type of hazardous phenomena called " drunkorexia " (i.e., using disordered eating to compensate for planned binge drinking).... more
Objective: Anecdotal claims insinuate that female Australian university students may be engaging in a new type of hazardous phenomena called " drunkorexia " (i.e., using disordered eating to compensate for planned binge drinking). However, to date, this conjecture has not been validated by empirical evidence. The primary aim of the present study was to estimate the frequency of drunkorexia behaviours in a population of non-clinical Australian undergraduate female university students. A secondary aim was to explore whether drunkorexia may be a stand-alone problem, separate from traditional eating disorders. Methods: One hundred and thirty-six healthy female Australian undergraduate university students between 18 and 25 years (M=21.32, SD=2.73) completed the self-report Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale to screen for drunkorexia symptomatology. Results: Among the study sample, 57.7% (n = 85) of Australian female university students reported drunkorexia-type behaviours 25% of the time or more, while 27.2% (n = 37) reported no drunkorexia-type behaviour. In addition, 16.2 8% (n = 22) of the participants reported engaging in characteristic drunkorexic behaviours to specifically offset ingested alcohol calories while not engaging in such behaviours routinely for any other reason or with any other type of food or drink. Conclusions: Results of this study add preliminary empirical evidence that a number of Australian female university students are employing drunkorexia-type behaviours as a way to drink alcohol without the concern of ingested calories. Further evidence is needed to definitively conclude that drunkorexia represents a distinctive problem that is separate from traditional eating disorders.
Research Interests:
Abstract Despite a decreasing trend in incidence and mortality, Cardiovascular Diseases (CVDs) still represent important causes of death and disability in developed countries, significantly affecting individuals’ quality of life and... more
Abstract Despite a decreasing trend in incidence
and mortality, Cardiovascular Diseases (CVDs) still
represent important causes of death and disability in
developed countries, significantly affecting individuals’
quality of life and healthcare costs . Unhealthy lifestyle
behaviors, such as poor diet, lack of physical activity and
smoking status, constitute a challenge in contrasting the
disease. Alternatively to the medical model, which rely
on the traditional approach of information and advicegiving,
evidence to date indicate the need of
psychological actions able to address patients’ beliefs and
concerns about their health status as well as to enhance
confidence in their abilities to overcome barriers to
adherence and achieve life‐style modifications in the long
term. Even if the World Health Organization (WHO) Expert
Committee stated that Cognitive‐Behavioural Therapy (CBT)
is an important component of Cardiac Rehabilitation (CR)
programs, it does not specifically focus on eliciting patients’
motivation, leading to the development of interventions aimed
at enhancing health behavior change and among which
Motivational Interviewing (MI) has obtained varying degrees
of success. Also, the new mHealth (mobile health) approach
could represent an important strategy in order to move
motivational psychological support where necessary
(outpatient settings), maximizing the results obtained from the
CR in a long term among people suffering from CVD and
other chronic conditions.
and mortality, Cardiovascular Diseases (CVDs) still
represent important causes of death and disability in
developed countries, significantly affecting individuals’
quality of life and healthcare costs . Unhealthy lifestyle
behaviors, such as poor diet, lack of physical activity and
smoking status, constitute a challenge in contrasting the
disease. Alternatively to the medical model, which rely
on the traditional approach of information and advicegiving,
evidence to date indicate the need of
psychological actions able to address patients’ beliefs and
concerns about their health status as well as to enhance
confidence in their abilities to overcome barriers to
adherence and achieve life‐style modifications in the long
term. Even if the World Health Organization (WHO) Expert
Committee stated that Cognitive‐Behavioural Therapy (CBT)
is an important component of Cardiac Rehabilitation (CR)
programs, it does not specifically focus on eliciting patients’
motivation, leading to the development of interventions aimed
at enhancing health behavior change and among which
Motivational Interviewing (MI) has obtained varying degrees
of success. Also, the new mHealth (mobile health) approach
could represent an important strategy in order to move
motivational psychological support where necessary
(outpatient settings), maximizing the results obtained from the
CR in a long term among people suffering from CVD and
other chronic conditions.
Research Interests:
An important international discussion began because of some pioneer studies carried out by Young (1996a) on the internet addiction disorder (IAD). In the fifth and most recent version of the Diagnostic, and Statistical Manual of Mental... more
An important international discussion began because of some pioneer studies carried out by Young (1996a) on the internet addiction disorder (IAD). In the fifth and most recent version of the Diagnostic, and Statistical Manual of Mental Disorders (DSM) there is no mention of this disorder and among researchers there are basically two opposite positions. Those who are in favor of a specific diagnosis and those who are claiming the importance of specific criteria characterizing this behavior and the precise role it has in the patient's life. The aim of the present paper is to answer the question whether it is possible or not to formulate diagnoses of internet-related disorders. We revised literature on the history of diagnostic criteria, on neurocognitive evidence, on the topic debate and on IAD instrumental measures. We found that the disorder was not univocally defined and that the construct was somehow too broad and generic to be explicative for a diagnosis. Indeed, the models are borrowed from other addiction pathologies and they are often formulated before the development of internet as intended in current society. In conclusion, we think we need a more innovative, integrated and comprehensive model for an IAD diagnosis.
Research Interests:
Research Interests:
Background: Obesity and being overweight are often associated with Binge Eating Disorder (BED). Cognitive-Behavioral Therapy (CBT) has shown solid results in reducing binge eating, but it does not traditionally encourage weight loss.... more
Background: Obesity and being overweight are often associated with Binge Eating Disorder (BED). Cognitive-Behavioral Therapy (CBT) has shown solid results in reducing binge eating, but it does not traditionally encourage weight loss. Since Brief Strategic Therapy (BST) has shown to be effective in treating obese people suffering from Binge Eating Disorder (BED), our objective is to compare the BST protocol as an alternative and/or integrative treatment to the traditional Cognitive-Behavioral Therapy, for inpatient and telephone-based outpatient treatment. Method: A two arm randomized controlled clinical trial including 6, 12 and 18 months post-treatment follow up is proposed. 60 participants meeting criteria for obesity and BED will be recruited from a single clinical center (Saint Joseph Hospital - Istituto Auxologico Italiano IRCCS) and randomly allocated in the CBT or BST group. The primary end point is the global change of patients’ progress score (Outcome Questionnaire - OQ 45.2), while the secondary outcome measures are patients’ weekly binge episodes and weight loss. Data will be collected before and after hospitalization (after 1 month) as well as at 6, 12 and 18 months from the end of the in-hospital treatment. Data at follow-up time points will be collected through tele- sessions. Conclusion: The present study represents the first randomized controlled trial aimed at comparing the effectiveness of BST with the gold standard CBT. These findings will advance current knowledge in both treatment for BED and telecommunication providing distant clinical healthcare.
Research Interests:
Background: The prevalence of diabesity (obesity and Type 2 diabetes) and prediabetes is increasing and the related complications are major public health concerns. The effective management of diabesity is crucial for the... more
Background: The prevalence of diabesity (obesity and Type 2 diabetes) and prediabetes is increasing and the related complications are major public health concerns. The effective management of diabesity is crucial for the prevention-limitation of related complications and for the reduction of health care costs. Regardless of clinical approach (life-style change, drugs, bariatric surgery), weight-loss and diabetes control programs involve for a long time repeated face-to-face control visits at clinical centers. Long-term programs that entails continuous monitoring and care are expensive and do not sustain patient motivation and treatment engagement. To face these problems, remote care and monitoring tools have been developed and assessed for feasibility, efficacy and cost effectiveness in few studies. Objective: The aim of the MObesity project is to develop a telemedicine platform that will improve the management of obesity with Type II diabetes or prediabetes in out-patient settings, providing an e-Health solution for the remote prevention, assessment and treatment of these diseases and related complications, improving a healthy lifestyle too. The project will have a special impact on improving quality of life and contributing to the cost-reduction and "cost-effective health care" improvement. Methods: 10 obese Type II diabetic and prediabetic patients will be recruited in a 6-month non-controlled pilot study aimed to assess the feasibility and usability of the MOBESITY web-platform. The clinical efficacy and cost-effectiveness of the MOBESITY program will be finally assessed within a 12-month RCT with two arms. 100 obese Type II diabetic and prediabetic patients will be randomized to two conditions: MOBESITY program (mHealth-based remote multidisciplinary management program) and standard care (usual state-of-the-art follow-up monitoring and care). Male and female Type II diabetic and prediabetic patients with BMI > 35 will be eligible for inclusion. Results: The primary expected outcomes are significant BMI (Body Max Index) reduction (at least 10% of baseline weight), weight loss maintenance (at least 5% lower than baseline weight) and glycemic level stabilization in the long-term. Secondary expected outcomes are significant QoL improvement, prevention or control of diabesity-related complications, cost reduction and compliance improvement (we expect a drop-out rate lower that 10%).
Conclusions: MOBesity will ensure:
1) CLINICAL INNOVATION; clinical units will not only collect single ranges of data, but will manage the disease in a multidisciplinary approach including biomedical, psychological, dietary and physical activity data improving the patient knowledge of his/her illness and the impact of rehabilitation procedures.
2) ORGANIZATIONAL INNOVATION; the traditional out-patient care will be provided in a new approach no longer using ambulatories or day-hospital admissions, but through a continuous Web-based monitoring and integrated treatment services that will significantly reduce the costs for the National Health Services and the time spent by patients attending clinics.
3) TECHNOLOGICAL INNOVATION; MOBESITY project will not develop new biomedical devices but will use the gold standard technology available on the market (such as biomedical t-shirts and "disappearing" mobile biosensors) in a new user-friendly "Science Gateway" platform integrated with e-Infrastructure to diagnose the presence of metabolic alterations of diabetes/prediabetes in obesity and to assess the severity or complications of diabesity.
Conclusions: MOBesity will ensure:
1) CLINICAL INNOVATION; clinical units will not only collect single ranges of data, but will manage the disease in a multidisciplinary approach including biomedical, psychological, dietary and physical activity data improving the patient knowledge of his/her illness and the impact of rehabilitation procedures.
2) ORGANIZATIONAL INNOVATION; the traditional out-patient care will be provided in a new approach no longer using ambulatories or day-hospital admissions, but through a continuous Web-based monitoring and integrated treatment services that will significantly reduce the costs for the National Health Services and the time spent by patients attending clinics.
3) TECHNOLOGICAL INNOVATION; MOBESITY project will not develop new biomedical devices but will use the gold standard technology available on the market (such as biomedical t-shirts and "disappearing" mobile biosensors) in a new user-friendly "Science Gateway" platform integrated with e-Infrastructure to diagnose the presence of metabolic alterations of diabetes/prediabetes in obesity and to assess the severity or complications of diabesity.
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Research Interests: Pain and Cronic Diseases
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This chapter recounts the story of my brother Valerio, a carrier of Brugada syndrome, and his experience with the Implantable Cardioverter Defibrillator (ICD). My name is Serena, I am a 25 year old psychologist, and with the present... more
This chapter recounts the story of my brother Valerio, a carrier of Brugada syndrome, and his experience with the Implantable Cardioverter Defibrillator (ICD). My name is Serena, I am a 25 year old psychologist, and with the present contribution I would like to give the reader an idea of what it means to face, from both my personal point of view and, indirectly, though my brother's words, the diagnosis of a genetic disease that makes ICD implantation necessary to survive. Specifically, I would like to try to explain how the implantation of the device affects the individu-al's life, relationships, and even parenting; but also how a person can successfully learn to live with a defibrillator, seeing the ICD as an important resource.
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One of the main benefits of the eHealth and mHealth approach is that it overcomes those limitations associated with the traditional, restricted and highly expensive in-patient treatment of many chronic pathologies, by reducing... more
One of the main benefits of the eHealth and mHealth approach is that it overcomes those limitations associated with the traditional, restricted and highly expensive in-patient treatment of many chronic pathologies, by reducing complications from a clinical, organizational and economic prospective. Mobile communication devices, therefore, may be an effective way to ensure long-term maintenance and improvement of health outcomes among patients with an implantable cardio-verter-defibrillator (ICD). Employment of eHealth and mHealth usually increases participation, compliance, and engagement toward treatment and helps clinicians by motivating patients in remote settings to withstand medical treatments and to copewith chronic conditions, also in a stepped-care approach. Clinical experiences and best practices regarding mHealth based strategies used to tele-monitor patients with
an ICD are reported/highlighted in this chapter which discusses ethodological, clinical and technological issues. At the end of the chapter future trends of eHealth–mHealth applications for ICDs are discussed.
an ICD are reported/highlighted in this chapter which discusses ethodological, clinical and technological issues. At the end of the chapter future trends of eHealth–mHealth applications for ICDs are discussed.
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The implantable cardioverter defibrillator (ICD) has established superiority in reducing mortality for survivors of cardiac arrest or patients at high risk of sudden death. However, because of the nature of their spontaneous, chronic, and... more
The implantable cardioverter defibrillator (ICD) has established superiority in reducing mortality for survivors of cardiac arrest or patients at high risk of sudden death. However, because of the nature of their spontaneous, chronic, and potentiality life-treating condition, patients with an ICD are at risk of developing mild to serious psychological distress. Critical events, such as ICD shocks or ICD recalls may occur, significantly altering the course of individuals' psychosocial adjustment; a number of studies from different countries demonstrate that patients with an ICD that experience higher emotional difficulties undergo a greater incidence of shock therapy.
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Introduction: according to the literature, psychosocial factors significantly contributeto both pathogenesis and expression of coronary artery disease (CAD). Depression, anxiety, anger and hostility, social isolation ... more
Introduction: according to the literature, psychosocial factors significantly contributeto both pathogenesis and expression of coronary artery disease (CAD). Depression, anxiety, anger and hostility, social isolation and stressful lifestyle represent the main contributing factors both to higher prevalence of unhealthy behaviors (poor diet, physical inactivity, alcohol use or smoking) and adverse pathophysiological mechanisms, such as neuroendocrine and platelet activation.
Material and method: over the past few decades, there has been an increasing
interest in investigating the relationship between psychosocial risk factors and
cardiovascular disease, leading to a growing pool of clinical and epidemiological data on the subject. Specifically, a large casecontrol trial, involving 52 countries, has identified nine potentially modifiable risk factors for CAD, among which psychosocial factors have been included and divided into two general categories: chronic stressors and emotional factors. These are believed to exacerbate the development of cardiovascular disease by two mechanisms: 1) encouraging unhealthy behaviors and increasing the noncompliance to treatments; and 2) eliciting physiological responses that may lead to insufficient oxygen delivery to the heart muscle, threatening heart rhythms, more vulnerable plaque, and the potential for blood clotting. Etiological controlled studies also confirmed this relationship. In this work, we outline the psychosocial domains significantly considered associated with increased risk of cardiovascular morbidity and mortality. We also discuss
critical pathophysiological mechanisms and pathways that, operating in a synergistic and integrative way, promote related clinical manifestations. Also, the impact of cardiac rehabilitation programs on psychological-related
cardiovascular events is discussed.
Discussion: the importance of psychosocial variables in the development, clinical manifestations, and prognosis of patients with heart disease received increased attention in recent years. However, the influence of psychosocial risk factors in cardiovascular disease remains underestimated when compared with the conventional ones. To recognize this relationship and to offers an important target for cardiovascular education, counseling and behavioral interventions, even after controlling for major risk factors. Cardiac rehabilitation programs considering amultidisciplinary approach are then widely recommended for the management of risk factors, nutritional, psychological, behavioral and social aspects potentially affecting patient outcomes.
Material and method: over the past few decades, there has been an increasing
interest in investigating the relationship between psychosocial risk factors and
cardiovascular disease, leading to a growing pool of clinical and epidemiological data on the subject. Specifically, a large casecontrol trial, involving 52 countries, has identified nine potentially modifiable risk factors for CAD, among which psychosocial factors have been included and divided into two general categories: chronic stressors and emotional factors. These are believed to exacerbate the development of cardiovascular disease by two mechanisms: 1) encouraging unhealthy behaviors and increasing the noncompliance to treatments; and 2) eliciting physiological responses that may lead to insufficient oxygen delivery to the heart muscle, threatening heart rhythms, more vulnerable plaque, and the potential for blood clotting. Etiological controlled studies also confirmed this relationship. In this work, we outline the psychosocial domains significantly considered associated with increased risk of cardiovascular morbidity and mortality. We also discuss
critical pathophysiological mechanisms and pathways that, operating in a synergistic and integrative way, promote related clinical manifestations. Also, the impact of cardiac rehabilitation programs on psychological-related
cardiovascular events is discussed.
Discussion: the importance of psychosocial variables in the development, clinical manifestations, and prognosis of patients with heart disease received increased attention in recent years. However, the influence of psychosocial risk factors in cardiovascular disease remains underestimated when compared with the conventional ones. To recognize this relationship and to offers an important target for cardiovascular education, counseling and behavioral interventions, even after controlling for major risk factors. Cardiac rehabilitation programs considering amultidisciplinary approach are then widely recommended for the management of risk factors, nutritional, psychological, behavioral and social aspects potentially affecting patient outcomes.